Propensity score-matched analysis of internal stent vs external stent for pancreatojejunostomy during pancreaticoduodenectomy: Japanese-Korean cooperative project: Pancreatic stents for pancreatojejunostomy

Manabu Kawai, Hiroki Yamaue, Jin Young Jang, Katsuhiko Uesaka, Michiaki Unno, Masafumi Nakamura, Tsutomu Fujii, Sohei Satoi, Seong Ho Choi, Masayuki Sho, Takumi Fukumoto, Song Cheol Kim, Tae Ho Hong, Wataru Izumo, Dong Sup Yoon, Ryosuke Amano, Sang Jae Park, Sae Byeol Choi, Hee Chul Yu, Joo Seop KimYoung Joon Ahn, Hongbeom Kim, Ryo Ashida, Seiko Hirono, Jin Seok Heo, Ki Byung Song, Joon Seong Park, Masakazu Yamamoto, Toshio Shimokawa, Sun Whe Kim

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background: Several studies comparing internal and external stents have been conducted with the aim of reducing pancreatic fistula after PD. There is still no consensus, however, on the appropriate use of pancreatic stents for prevention of pancreatic fistula. This multicenter large cohort study aims to evaluate whether internal or external pancreatic stents are more effective in reduction of clinically relevant pancreatic fistula after pancreaticoduodenectomy (PD). Methods: We reviewed 3149 patients (internal stent n = 1,311, external stent n = 1838) who underwent PD at 20 institutions in Japan and Korea between 2007 and 2013. Propensity score matched analysis was used to minimize bias from nonrandomized treatment assignment. The primary endpoint was the incidence of clinically relevant pancreatic fistula. This study was registered on the UMIN Clinical Trials Registry (UMIN000032402). Results: After propensity score matched analysis, clinically relevant pancreatic fistula occurred in more patients in the external stents group (280 patients, 28.7%) than in patients in the internal stents group (126 patients, 12.9%) (OR 2.713 [95% CI, 2.139–3.455]; P < 0.001). In subset analysis of a high-risk group with soft pancreas and no dilatation of the pancreatic duct, clinically relevant pancreatic fistula occurred in 90 patients (18.8%) in internal stents group and 183 patients (35.4%) in external stents group. External stents were significantly associated with increased risk for clinically relevant pancreatic fistula (OR 2.366 [95% CI, 1.753–3.209]; P < 0.001). Conclusion: Propensity score matched analysis showed that, regarding clinically relevant pancreatic fistula after PD, internal stents are safer than external stents for pancreaticojejunostomy. A multicenter large cohort study by propensity score matched analysis showed that internal stents for pancreaticojejunostomy are safer than external stents regarding pancreatic fistula. The importance of this finding is that internal stents for pancreaticojejunostomy might reduce clinically relevant pancreatic fistula after pancreaticoduodenectomy.

Original languageEnglish
Pages (from-to)984-991
Number of pages8
JournalPancreatology
Volume20
Issue number5
DOIs
Publication statusPublished - 2020 Jul

Keywords

  • External stent
  • Internal stent
  • Pancreatic fistula
  • Pancreaticoduodenectomy

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Gastroenterology

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